Uncovered

WL man files formal complaint about Cover Oregon, Moda Health

The first sign of trouble for Mark Evertz and his new health care plan came when his wife, Amy, went to pick up a prescription Jan. 8.

The pharmacist told her that, according to their records, she was 28 years old  far off her actual age of 45.

When Amy Evertz told her husband about the mistake, alarm bells began to ring. He had just paid the bill for the familys first month of coverage under Moda Health and Dental  a new plan he had found using the Cover Oregon exchange agency. If Moda had his wifes age wrong, the familys premium would likely skyrocket once the mistake was corrected.

Evertzs suspicions proved correct, but he never anticipated the dizzying sequence of events that ultimately prompted him to file a formal complaint at the Oregon Department of Consumer and Business Services Jan. 13 against both Moda and Cover Oregon.

It was the second complaint the department received regarding Cover Oregon, according to Consumer and Business Services spokeswoman Cheryl Martinis  though she stressed that it was not a legal complaint and was strictly related to consumer service.

Like scores of others, Evertz began working with Cover Oregon  the state-run health insurance marketplace created as part of the 2010 Affordable Care Act  this past October to find new health and dental plans for his family. He also consulted with Gelfand Insurance Group in West Linn to assure he was finding the best rates.

The first plan he came up with had health insurance provided by the HealthNet and dental from Moda.

Doing that, we felt like we were all good, Evertz said. We got accepted, and they notified us that we were in the system.

Yet when Evertz logged in online to pay his first bill in December, he found that Moda had him set up for both medical and dental plans, thus leaving him doubled up on health care with two insurance companies. Though frustrated at first, Evertz learned that the joint medical-dental plan from Moda was actually cheaper than the original plan that combined HealthNet and Moda.

He notified Cover Oregon, HealthNet and Moda of his intent to keep the Moda plan, and the issue could have ended right there.

But then came the bizarre age mistake at the pharmacy, and Evertzs inquiries to Moda went unanswered.

When he went to check his MyModa account online, Evertz found that items were starting to disappear from his plan entirely.

His familys health care plan had vanished.

I started rattling cages, Evertz said. Moda customer service said, You have dental, but not health care. I said that I paid for it, and someone deleted it from their system. They denied that.

Moda representatives told Evertz that the directions to alter his plan came from Cover Oregon, but when Evertz spoke with a customer service representative at the health care exchange agency, he was told that Cover Oregon did not have the ability to change or delete items in his plan  and that the cheaper Moda package he thought he had signed up for in fact did not exist at all in the Cover Oregon system.

I cant emphasize enough that, while Cover Oregon was a tragic comedy of errors, they worked hard to fix it for me when I got a hold of them, Evertz said.

It was Modas response that ultimately drove Evertz to file a complaint to the Department of Consumer and Business Services. To remedy the mix up, Moda reinstated Evertzs health plan  this time with a much higher $3,000 annual deductible as opposed to the $750 he originally signed up for.

Evertz continued to negotiate with Moda after filing the complaint, and by Jan. 15 the health insurance company had proposed a counter offer that would result in Evertz paying about $241 more per month for health and dental coverage.

Initially due to a clerical error, Moda Health enrolled you and your family in a cost share reduction variation of the Be Smart Plan, Moda HealthCare Reform Manager Theresa Barney wrote in an email to Evertz. This variation is only available to those members whose income is at specific levels of the federal poverty level. At this time from the information we have available to us and through our conversation (Jan. 15), you and your family are not eligible for this plan variation.

The problem began with the application he faxed to Cover Oregon was mishandled as it made its way from paper into digital format for Moda, Moda spokesman Jonathan Nicholas said.

Evertz ultimately decided to accept Modas new offer, but he wont revoke the complaint.

I still encourage the (Department of Consumer and Business Services) to look into it, Evertz said.

In the midst of it all, Evertz wants to make one thing clear: He isnt some sort of trailblazer or an activist trying to bring down the troubled Cover Oregon system. He just wants to protect his familys interests.

Clearly Cover Oregon has its share of problems and its been drawn out in media pretty readily, Evertz said. But in my case its important to note there are other people in this case who have equal fault, and they took action without notifying my family.

Blame can be shared and owned up to by the insurance companies, and to some degree they have.

When contacted, Cover Oregon did not wish to comment on the complaint.